Page 35 - World Journal of Laparoscopic Surgery

Perioperative Outcome of Laparoscopy in the Management of Periappendiceal Abscess
with no statistically significant difference between the LA and the Clinical Significance
OA groups. The recurrence of the postoperative intraperitoneal Laparoscopic surgery for appendicitis complicated with an abscess
collection has been attributed to the absence of skillful surgeons, is feasible and safe. It offers beneficial merits over the open
improper manipulation, and techniques like an excessive residual approach including the perioperative and financial outcome.
of the fluids of lavage in the peritoneal cavity, which in turn causes
considerable contamination. An uncontrollable manipulation of
complicated appendicitis, especially the ruptured one; moreover, orcId
CO insufflation can facilitate the intraperitoneal spread of bacteria. Selmy S Awad https://orcid.org/0000-0002-2724-5599
2
In the current research, the rate of intra-abdominal collection
recurrence of the LA group had no significant difference from that references
of the OA group. We consider that the skillful laparoscopic surgeon 1. Taguchi Y, Komatsu S, Sakamoto E, et al. Laparoscopic versus open
is the key part of this finding, which was supported before by some surgery for complicated appendicitis in adults: A randomized
authors. 38,39 The antibiotics therapy was administered regularly per controlled trial. Surg Endosc 2016;30(5):1705–1712. DOI: 10.1007/
and postoperative in LA in our cases. Despite the high incidence s00464-015-4453-x.
of recurrent formation of the intra-abdominal collection being a 2. Thomson JE, Kruger D, Jann-Kruger C, et al. Laparoscopic versus open
little higher after LA, greater improvements in our technique may surgery for complicated appendicitis: a randomized controlled trial
eradicate this serious event. to prove safety. Surg Endosc 2015;29(7):2027–2032. DOI: 10.1007/
One (0.7) patient in the LA group had intestinal obstruction, s00464-014-3906-y.
whereas in the OA group, 2 (.8) patients had an intestinal obstruction 3. Katkhouda N, Mason RJ, Towfigh S, et al. Laparoscopic versus open
appendectomy: a prospective randomized double-blind study. Ann
in the early postoperative period due to fibrinous adhesions, and Surg 2005;242(3):439–450. DOI: 10.1097/01.sla.0000179648.75373.2f.
2 (.8%) patients had adhesive intestinal obstruction after 17 and 4. Keckler SJ, Tsao K, Sharp SW, et al. Resource utilization and outcomes
19 weeks, respectively. This can be attributed to the fact that from percutaneous drainage and interval appendectomy for
the laparoscopic approach was more exploratory than the open perforated appendicitis with abscess. J Pediatr Surg 2008;43(6):
approach and it could dissect adhesions made by inflammatory 977–980. DOI: 10.1016/j.jpedsurg.2008.02.019.
processes compared with the open approach, and to the fact that 5. You KS, Kim DH, Yun HY, et al. The value of a laparoscopic interval
the absence of the large abdominal wall wounds prevents the appendectomy for treatment of a periappendiceal abscess:
intestine from adhering to the wound scar, which occurred with the experience of a single medical center. Surg Laparosc Endosc Percutan
Tech 2012;22(2):127–310. DOI: 10.1097/SLE.0b013e318244ea16.
41
open approach. LA was associated with lower odds for developing 6. Tanaka Y, Uchida H, Kawashima H, et al. More than one-third of
any SC in the multivariate analysis. successfully nonoperatively treated patients with complicated
The laparoscopic equipment was costly ($300 in our appendicitis experienced recurrent appendicitis: is interval
institutions) compared with the traditional open approach ($30 appendectomy necessary? J Pediatr Surg 2016;51:1957–1961.
in our hospital settings) and they did not represent an obstacle DOI: 10.1016/j.jpedsurg.2016.09.017.
to their valuable utilization. This higher cost of instruments was 7. Chau DB, Ciullo SS, Watson-Smith D, et al. Patient-centered outcomes
little compensated by the shorter LOS, so the total expenses of research in appendicitis in children: Bridging the knowledge gap. J
management were a little higher by $300 in the LA. Also from a Pediatr Surg 2016;51(1):117–121. DOI: 10.1016/j.jpedsurg.2015.10.029.
social perspective, it was noticed by Moore et al. that LA gained 8. St Peter SD, Aguayo P, Fraser JD, et al. Initial laparoscopic
appendectomy versus initial nonoperative management and
a significant economic concern as a quicker return to normal interval appendectomy for perforated appendicitis with abscess:
activities and work is so beneficial, especially for the productive a prospective, randomized trial. J Pediatr Surg 2010;45(1):236–240.
young population in life. 42 DOI: 10.1016/j.jpedsurg.2009.10.039.
The limitation of this research included its limited centers 9. Deelder JD, Richir MC, Schoorl T, et al. How to treat an appendiceal
design, the small sample size, and the choice of the technique as inflammatory mass: operatively or nonoperatively?. J Gastrointest
it was a surgeon’s decision and patient criteria. The selection of Surg. 2014;18(4):641–645. DOI: 10.1007/s11605-014-2460-1.
patients for the laparoscopic approach was biased by presentation 10. Kleif J, Vilandt J, Gögenur I. Recovery and convalescence after
duration, age of the patients, and surgeon preference. It is still laparoscopic surgery for appendicitis: a longitudinal cohort study.
J Surg Res 2016;205(2):407–418. DOI: 10.1016/j.jss.2016.06.083.
controversial to perform LA with inexperienced hands with respect 11. Ukai T, Shikata S, Takeda H, et al. Evidence of surgical outcomes
to the severe inflammatory reaction present. fluctuates over time: results from a cumulative meta-analysis of
In brief, the clinical support gained from this research gives the laparoscopic versus open appendectomy for acute appendicitis. BMC
upper hand for LA in the management of cases with PA in terms of Gastroenterol. 2016;16:37. DOI: 10.1186/s12876-016-0453-0.
early recovery of gastrointestinal functions, SCs, and hospital stay. 12. Wu JX, Dawes AJ, Sacks GD, et al. Cost effectiveness of nonoperative
We suggest that the utilization of this finding should be management versus laparoscopic appendectomy for acute
generalizable if the institution has laparoscopically skillful surgeons uncomplicated appendicitis. Surgery 2015;158(3):712–721. DOI:
and sufficient laparoscopic resources. 10.1016/j.surg.2015.06.021.
13. Pokala N, Sadhasivam S, Kiran RP, et al. Complicated appendicitis–is
the laparoscopic approach appropriate? A comparative study with
conclusIons the open approach: outcome in a community hospital setting. Am
Laparoscopic surgery for appendicitis complicated with an abscess Surg 2007;73(8):737–742.
is feasible and safe. It offers clinically beneficial merits over the open 14. Pirro N, Berdah SV. Appendicites: coelioscopie ou non? [Appendicitis:
yes or no to laparoscopic approach?]. J Chir (Paris). 2006;143(3):
approach (including shorter LOS, less postoperative analgesia, early 155–159. DOI: 10.1016/s0021-7697(06)73643-2.
start of oral feeding, faster return to normal daily work, and lower 15. So JBY, Chiong EC, Chiong E, et al. Laparoscopic appendectomy
incidence of postoperative complications) against marginally longer for perforated appendicitis. World J Surg. 2002;26(12):1485–1488.
operative time and higher hospital costs. DOI: 10.1007/s00268-002-6457-7.

34 World Journal of Laparoscopic Surgery, Volume 16 Issue 1 (January–April 2023)